Endodontics Section - Therapeutic Pulpotomy
| Topic: Therapeutic
Pulpotomy |
Last Reviewed Date:
01/2003 |
| Section: Endodontics |
Policy No: 22B |
| Revised/Effective Date: 01/2003
|
Next Review Date: 01/2005 |
IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of
generally accepted standards of dental practice, review of dental literature,
dental necessity, and as appropriate, government approval.
Benefit determinations should be based
in all cases on the applicable contract language.
To the extent there are any conflicts between these guidelines and the
contract language, the contract language will control.
The purpose of dental policy is to provide a guide to coverage. Dental
policy is not intended to dictate to providers how to practice dentistry.
Providers are expected to exercise their clinical judgment in providing
the most appropriate care.
|
Description
Therapeutic pulpotomy (excluding final restoration)
– removal of pulp coronal to the dentinocemental
junction and application of medicament (D3220):
Pulpotomy is the surgical removal of a portion of
the pulp with the aim of maintaining the vitality
of the remaining portion by means of an adequate dressing.
To be performed on primary or permanent teeth.
This is not to be construed as the first stage of root
canal therapy
Policy/Criteria
Procedures are in accordance with generally accepted
standards of dental practice.
Administrative Guidelines
Process to contract benefits.
| Codes |
Number |
Description |
| CDT |
D3000-D3999 |
See above |
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|
